Emerg Med J 30:123-129 doi:10.1136/emermed-2011-200760
  • Original articles

Modified early warning score with rapid lactate level in critically ill medical patients: the ViEWS-L score

  1. Bo Young Park3
  1. 1Department of Emergency Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea
  2. 2School of Medicine, Chonbuk National University, Jeonju, Korea
  3. 3National Cancer Control Institute, National Cancer Center, Goyang si, Kyunggi do, Korea
  1. Correspondence to Dr Jae Baek Lee, Department of Emergency Medicine, Chonbuk National University Hospital, 20 Gunji-ro, 634-18, Geumam-dong, Jeonju-si, Jeonlabuk-do 561-712, Republic of Korea; baeklee{at}
  1. Contributors Conception and design: SJ and JBL. Analysis and interpretation: SJ and BP. Drafting the manuscript for important intellectual content: SJ. Review: YHJ, TOJ, JCY and YKJ. Final approval: SJ and JBL.

  • Accepted 12 February 2012
  • Published Online First 16 March 2012


Objectives To examine whether the predictive value of the early warning score (EWS) could be improved by including rapid lactate levels, and to compare the modified EWS with the pre-existing risk scoring systems.

Design Retrospective observational study in South Korea.

Setting An urban, academic, tertiary hospital.

Participants Consecutive adult patients who were admitted to the medical intensive care unit via the emergency department (ED).

Outcome measures A newly developed EWS—the VitalPAC EWS (ViEWS), was used in the present study. Lactate level, ViEWS and HOTEL score were obtained from patients at presentation to the ED, and APACHE II, SAPS II and SAPS III scores were obtained after admission. The area under curve of each risk scoring system for in-hospital, 1-week, 2-week and 4-week mortality was compared.

Results 151 patients were enrolled and the mortality was 42.4%. The ViEWS-L score was calculated as follows: ViEWS-L score=ViEWS+lactate (mmol/l) according to the regression coefficient. The mean ViEWS-L score was 11.6±7.3. The ViEWS-L score had a better predictive value than the ViEWS score for hospital mortality (0.802 vs 0.742, p=0.009), 1-week mortality (0.842 vs 0.707, p<0.001), 2-week mortality (0.827 vs 0.729, p<0.001) and 4-week mortality (0.803 vs 0.732, p=0.003). The ViEWS-L score also had a better predictive value than the HOTEL and APACHE II scores. The predictive value of ViEWS-L was comparable with SAPS II and SAPS III.

Conclusions The ViEWS-L score performed as well as or better than the pre-existing risk scoring systems in predicting mortality in critically ill medical patients who were admitted to the medical intensive care unit via the ED.


  • Competing interests None.

  • Patient consent This is a retrospective chart review study and waiver of patient consent was given by the institutional review board of the study hospital.

  • Ethics approval The study was approved by the institutional review board of Chonbuk National University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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